Sarcoidosis is an idiopathic disease characterized by non-caseating granulomas, and although it commonly presents as a pulmonary disease (95% of patients), it can affect virtually any organ system (30% of patients present with an extrapulmonary manifestation). Interestingly, women are more likely to have skin or ocular involvement and men are more likely to have cardiac involvement.

Ocular (25%): including uveitis, keratoconjunctivitis sicca, and eyelid or conjunctival granulomas as well as lacrimal gland involvement and orbital masses

Upper respiratory tract (15%): laryngeal and nasal/sinus disease (can be atrophic or more nodular) DON'T BE FOOLED: sinus granulomatosis can also be associated with granulomatosis with polyangiits and syphilis!

Biopsy is often required to make the diagnosis--but certain cases such as presentations of Lofgren syndrome (erythema nodosum, hilar adenopathy, migratory polyarthralgia, and fever) are so classic that biopsy is not necessary.

Most often, sarcoidosis is benign--but no clinical parameters allow an accurate prediction of the clinical course of this disease. Lung fibrosis, cutaneous disease, and neurologic disease do suggest chronicity. Some extrapulmonary manifestations require prompt treatment as summarized in this In the Clinic article from Annals 2012: